Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2016May 16, 2017
Questions for Robin Cohen, Ph.D., Health Statistician and Lead Author on “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2016”
Q: Have the total number of uninsured leveled off since the Affordable Care Act (ACA) was implemented?
RC: In 2016, 28.6 million or 9.0% of persons of all ages were uninsured at the time of interview, this is 20 million fewer persons than in 2010 and no change from 2015. However, it is too soon to tell if there has been a leveling off in the number of uninsured.
Q: Since 2010, were there any trends among uninsured adults by age groups?
RC: Among adults aged 18–64, the rate of uninsurance at the time of interview remained relatively stable from 2010 through 2013 for all age groups except adults aged 18–24. Among adults aged 18–24 the percentage of those who were uninsured decreased from 31.5% in 2010 to 25.9% in 2011, and then remained stable through 2013. For all age groups, the percentage who were uninsured decreased significantly from 2013 through 2016.
Q: What did your report find on state-specific health insurance estimates for 2016?
RC: State-specific health insurance estimates for persons aged 18–64 in 2016 are presented for 45 states. Among these 45 states presented for 2016, California, Connecticut, Delaware, Hawaii, Illinois, Iowa, Maryland, Massachusetts, Michigan, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, Washington, and Wisconsin had significantly lower percentages of uninsured adults than the national average (12.4%). Florida, Georgia, Idaho, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, and Texas had significantly higher percentages of uninsured adults than the national average. Among the 45 states presented in this report, only California had a significant decrease in the percentage of adults aged 18–64 who were uninsured between 2015 (11.1%) and 2016 (9.5%).
Q: How come you only have data for 45 states instead of the whole country?
RC: Estimates are not presented for all 50 states and the District of Columbia due to considerations of sample size and precision. States with fewer than 1,000 interviews for persons of all ages are excluded. In addition, estimates for children in states that did not have at least 300 children with completed interviews are not presented.
Q: Was there anything in your report that surprised you?
RC: The percentage of persons aged 18–64 who were enrolled in exchange plans has remained relatively stable from the first quarter of 2016 (4.7% or 9.2 million) through the fourth quarter of 2016 (4.8% of 9.4) million. This was surprising because for both 2014 and 2015 we observed a drop in exchange coverage in the fourth quarter.
Changes in Characteristics of Chronically Uninsured Adults: Early Release of Estimates From the National Health Interview Survey, 2010–September 2016April 27, 2017
Questions for Emily P. Zammitti, M.P.H., Associate Service Fellow and Lead Author on “Changes in Characteristics of Chronically Uninsured Adults: Early Release of Estimates From the National Health Interview Survey, 2010–September 2016.”
Q: What do you mean by the “chronically uninsured?”
EZ: For the purposes of this report, persons were defined as chronically uninsured if they were uninsured at the time of interview and had lacked coverage for more than 1 year.
Q: What groups are more likely to be chronically uninsured?
EZ: We have to be careful about how we speak about the results of this report. The focus of this report is the population who are chronically uninsured. Therefore it does not address which groups are more likely to be chronically uninsured. Among the chronically uninsured, certain groups are larger than others. In the first 9 months of 2016, the proportion of chronically uninsured adults who lived in the South was larger than the proportion who lived in the Northeast, Midwest, or West regions. The proportion who were aged 45-64 was larger than the proportion who were aged 18-25, 26-34, and 35-44. The proportion who were Hispanic was larger than the proportion who were non-Hispanic white, non-Hispanic black, non-Hispanic Asian, and non-Hispanic other race. The proportion who rated their health as excellent or very good was larger than the proportion who rated their health as either good or fair or poor. A major focus of this report is how these proportions have changed since 2010.
Q: How many of the chronically uninsured are younger people who in many cases are healthy vs. older people who are much more likely to need insurance?
EZ: In the first 9 months of 2016, we estimate that 16% of chronically uninsured adults aged 18-64 were aged 18-25, 25.2% were aged 26-34, 26.8% were aged 35-44, and 32% were aged 45-64. Since 2010, the proportion of chronically uninsured adults who were aged 18-25 has decreased, and the proportion who were aged 35-44 and 45-64 increased. For this report, we did not disaggregate health status by age.
Q: Are there more chronically uninsured people in states that did not expand Medicaid?
EZ: We did not look at the chronically uninsured population stratified by state Medicaid expansion status for this report. However, we do look at the percent who are uninsured at the time of interview, which includes both chronically and short-term uninsured, by state Medicaid expansion status in our quarterly Health Insurance Early Release report. The percentage who are uninsured is higher in states which have not expanded Medicaid, compared with states which have expanded Medicaid.
Q: What in this new analysis did you find most interesting?
EZ: The first figure in our report shows that since 2010, the percentage of adults aged 18-64 who are chronically uninsured has been cut by more than half from 16.8% in 2010 to 7.6% in the first 9 months of 2016.
Q: When will you have full-year numbers available for 2016?
EZ: Full year 2016 Early Release data will be available on May 17th, 2017 through the Research Data Centers. That’s also when the next Health Insurance Early Release report will come out. Full year final data are expected to be released at the end of June 2017, six months after the completion of data collection.
Q: What do you make of the finding that the percent of chronically uninsured who are unemployed has been dropping while the percent who are employed has been increasing?
EZ: We don’t propose potential explanations for the results of this report, that’s outside of the scope of our work, but we did see a decrease in the proportion of chronically uninsured adults aged 18-64 who were unemployed from 16.3% in 2010 to 10.1% in the first 9 months of 2016, with a corresponding increase in the proportion who were employed during this time period.
Q: Anything else you feel is noteworthy about your study?
EZ: lthough the majority of chronically uninsured adults rate their health as excellent or very good, this proportion has not changed significantly from 2010 to the first 9 months of 2016. This means that the chronically uninsured population aged 18-64 is not more or less healthy (according to their self-rated responses) in the first 9 months of 2016 than in 2010.
CDC’s National Center for Health Statistics has updated its “Stats of the States” feature on the NCHS web site. This resource features the latest state-by-state comparisons on key health indicators ranging from birth topics such as teen births and cesarean deliveries to leading causes of death and health insurance coverage.
Tabs have been added to the color-coded maps to compare trends on these topics between the most recent years (2015 and 2014) and going back a decade (2005) and in some cases further back.
To access the main “Stats of the States” page, use the following link:
Utilization of Clinical Preventive Services for Cancer and Heart Disease Among Insured Adults: United States, 2015March 8, 2017
Questions for Anjel Vahratian, Supervisory Statistician (Health) and Lead Author on “Utilization of Clinical Preventive Services for Cancer and Heart Disease Among Insured Adults: United States, 2015”
Q: Why did you decide to look at clinical preventive services for cancer and heart disease among insured adults?
AV: Heart disease and cancer are the top two leading causes of death in the United States. The clinical preventive services discussed in this report are recommended for the prevention or early detection of heart disease and cancer. We limited our analysis to insured adults because most insurance plans were required to cover these clinical preventive services without co-payment from the insured adult in 2015.
Q: What did your report find out about cancer screenings among insured adults?
AV: In 2015, two-thirds of insured adults aged 50-75 were screened for colorectal cancer within the recommended intervals, and screening was significantly associated with age for both men and women. Insured women aged 50-59 were more likely to be screened for colorectal cancer compared with men of the same age. Among insured women, more than 8 out of 10 of those aged 21-65 had been screened for cervical cancer, and nearly 3 out of 4 of those aged 50-74 had been screened for breast cancer within the recommended intervals.
Q: What did your report find out about heart disease screenings among insured adults?
AV: In 2015, more than 8 in 10 insured adults aged 18 and over had their blood pressure checked by a doctor or other health professional, and about 2 in 3 overweight and obese insured adults aged 40-70 had a fasting blood test for high blood sugar or diabetes in the past 12 months. Receipt of these services increased with advancing age and varied by sex. Insured women aged 18-39 and 40-64 were more likely than their male peers to have their blood pressure checked in the past 12 months, and insured overweight and obese women aged 40-49 were more likely than men of the same age and BMI to have a fasting blood test or diabetes in the past 12 months.
Q: Was there a specific finding that you found surprising?
AV: It was surprising that only 49.5% of overweight and obese insured men aged 40-49 had a fasting blood test for diabetes in the past 12 months. Diabetic adults are at increased risk of developing cardiovascular disease, and overweight and obesity and abnormal blood glucose are modifiable cardiovascular risk factors.
Q: What is the take home message of this report?
AV: Utilization of clinical preventive services aimed at the early detection of cancer and cardiovascular disease varied by sex and age among insured adults. Insured adults in their 40s and 50s were less likely than those in their 60s to be screened for colorectal cancer, high blood pressure, and diabetes. Limited knowledge about the recommendations for clinical preventive services may prevent eligible adults from seeking out timely preventive care.